Republic of the Philippines

City/Municipality of __________________
BAGUIO
Province of __________________________
BENGUET

UNIFIED APPLICATION FORM FOR BUILDING PERMIT

SIMPLE COMPLEX*
NEW RENEWAL AMENDATORY

THIS APPLIES ALSO FOR : LOCATIONAL CLEARANCE FIRE SAFETY EVALUATION CLEARANCE
APPLICATION NO. AREA NO.

BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE APPLICANT)

OWNER / APPLICANT LAST NAME FIRST NAME M.I. TIN
DO NOT FILL-UP (PSA USE ONLY)
PJ LHUILLIER INC./PUYAWAN ARTEMIO S.
FOR CONSTRUCTION OWNED FORM OF OWNERSHIP
BY AN ENTERPRISE LESSEE
ADDRESS: NO., STREET, BARANGAY, CITY / MUNICIPALITY ZIP CODE CONTACT NO.
PJL CENTER 1782 N. GARCIA COR. CANDELARIA STS, MAKATI 09457615275
LOCATION OF CONSTRUCTION: LOT NO. _______
K-06 BLK NO. ________ TCT NO. ______________
n/a CURRENT TAX DEC. NO. ____________________
2021-07-028-001450
BAGUIO CITY
STREET_____________________
ZANDUETA BARANGAY __________________________ CITY- OTEK
ABANAO - ZANDUETA - KAYONG - CHUGUM / MUNICIPALITY
(AZKCO) OF_____________________________________
CITY/MUNICIPALITY OF
SCOPE OF WORK
NEW CONSTRUCTION ✔ RENOVATION RAISING
ERECTION CONVERSION ACCESSORY BUILDING/STRUCTURE
ADDITION REPAIR LEGALIZATION OF EXISTING BUILDING
ALTERATION MOVING OTHERS (Specify)
USE OR CHARACTER OF OCCUPANCY
GROUP H : ASSEMBLY (OCCUPANT
GROUP A : RESIDENTIAL (DWELLINGS) GROUP E : COMMERCIAL LOAD LESS THAN 1,000)
SINGLE DUPLEX RESIDENTIAL R-1, R-2 BANK STORE SHOPPING THEATER, AUDITORIUM, CONVENTION HALL,
OTHERS ______________________________________ DRINKING / DINING CENTER / MALL GRANDSTAND/ BLEACHER
GROUP B : RESIDENTIAL ESTABLISHMENT OTHERS ______________________________
HOTEL MOTEL TOWNHOUSE SHOP (i.e. DRESS SHOP, TAILORING,
DORMITORY BOARDINGHOUSE, BARBERSHOP, etc.) GROUP I : ASSEMBLY (OCCUPANT
RESIDENTIAL R-3, R-4, R-5 LODGING HOUSE OTHERS ______________________________
` LOAD 1,000 OR MORE)
COLISEUM, SPORTS COMPLEX,
OTHERS _______________________________________ GROUP F : LIGHT INDUSTRIAL CONVENTION CENTER AND SIMILAR
GROUP C : EDUCATIONAL & RECREATIONAL FACTORY / PLANT (USING INCOMBUSTIBLE/ STRUCTURE
SCHOOL BUILDING SCHOOL AUDITORIUM, NON-EXPLOSIVE MATERIALS OTHERS _______________________
CIVIC CENTER GYMNASIUM OTHERS ______________________________
`
CLUBHOUSE CHURCH, MOSQUE, GROUP J : (J-1) AGRICULTURAL
TEMPLE, CHAPEL GROUP G : MEDIUM INDUSTRIAL BARN, GRANARY, POULTRY HOUSE,
OTHERS _______________ PIGGERY, GRAIN MILL, GRAIN SILO
STORAGE / WAREHOUSE (FOR HAZARDOUS/
GROUP D : INSTITUTIONAL HIGHLY FLAMMABLE MATERIALS OTHERS _______________________
HOSPITAL OR SIMILAR STRUCTURE FACTORY (FOR HAZARDOUS/ HIGHLY GROUP J : (J-2) ACCESSORIES
HOME FOR THE AGED FLAMMABLE MATERIALS PRIVATE CARPORT / GARAGE, TOWER,
GOVERNMENT OFFICE OTHERS _______________________________ SWIMMING POOL, FENCE OVER 1.80m,
STEEL / CONCRETE TANK
OTHERS _______________________________________ OTHERS _______________________
OCCUPANCY CLASSIFIED_____________________________ TOTAL ESTIMATED COST: P ______________________________________
655662.04
1
NUMBER OF UNITS__________________________________ BUILDING ____________________________ COST OF EQUIPMENT INSTALLED:
NUMBER OF STOREY________________________________
1 ELECTRICAL ____________________________ P ______________________________
TOTAL FLOOR AREA ___________________________
200 SQ. M. MECHANICAL____________________________ P ______________________________
LOT AREA ____________________________________
19.72 SQ. M ELECTRONICS___________________________ P ______________________________
PLUMBING ___________________________ P ______________________________
MARCH 1, 2024
PROPOSED DATE OF CONSTRUCTION: _______________________________ EXPECTED DATE OF COMPLETION: _______________________________
APRIL 01, 2024

BOX 2
FULL-TIME INSPECTOR AND SUPERVISOR OF CONSTRUCTION WORKS (REPRESENTING THE OWNER)
Address
AR. LELANI MADRIGAL BINAN, LAGUNA
PRC No. 14425 Validity 12/29/22026
ARCHITECT OR CIVIL ENGINEER
PTR No. 1935365 Date Issued 01/05/2024
(Signed and Sealed Over Printed Name)
Date_____________________________ Issued at SAN PEDRO, LAGUNA TIN 201-175-409
BOX 3 BOX 4
APPLICANT: WITH MY CONSENT: LOT OWNER / AUTHORIZED REPRESENTATIVE
MR. ARTEMIO S. PUYAWAN PACIFIC LAND & BLDG. CORP./NANCY
CHAN
Date ______________ Date______________
(Signature Over Printed Name) (Signature Over Printed Name)

Address 107 QUIRINO AVENUE CITY OF PARAÑAQUE NCR, 4TH DISTRICT (NOT A PROVINCE)Address ABANAO SQUARE MALL

Gov’t Issued ID No. 4935-6237-1309-6314

Date Issued 05-24-23 Place Issued TARLAC Gov’t Issued ID No. Date Issued Place Issued
BOX 5
REPUBLIC OF THE PHILIPPINES ) S.S
CITY/MUNICIPALITY OF _________________________________________)
BEFORE ME, at the City/Municipality of _____________________________________________________ , on _________________________ personally appeared the
following:
MR. ARTEMIO S. PUYAWAN
______________________________________________________ _____________________
4935-6237-1309-6314 _______________
05-24-23 ___________________________________
TARLAC,TARLAC
APPLICANT Gov’t Issued ID No. Date Issued Place Issued
AR. LELANI M. MADRIGAL
______________________________________________________ 14425
_____________________ 12-29.24
_______________ MUNTINLUPA CITY
___________________________________
LICENSED ARCHITECT OR CIVIL ENGINEER Gov’t Issued ID No. Date Issued Place Issued
(Full-Time Inspector and Supervisor of Construction Works)

whose signatures appear hereinabove, known to me to be the same persons who executed this standard prescribed form and acknowledged to me that the same is their free and
voluntary act and deed.
WITNESS MY HAND AND SEAL on the date and place above written.
Doc. No. ____________
Page No.____________ ________________________________________________________
Book No.____________ NOTARY PUBLIC (Until December _____________ )
Series of ____________

Copy 1: Owner Copy 2: OBO Copy 3: BFP Copy 4: Philippine Statistics Authority
*May require additional requirements
 BOX 6 (TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION)

BASIS OF AMOUNT
ASSESSED FEES ACCOUNT ASSESSED BY
ASSESSMENT DUE
FOR ZONING (ZONING
ADMINISTRATOR):
 LOCATIONAL / ZONING OF LAND

FOR BUILDING / STRUCTURE (OBO):

 FILIN
FILING FEE
 G FEE
 LINE AND GRADE (Geodetic)

 FENCING

 ARCHITECTURAL

 CIVIL / STRUCTURAL

 ELECTRICAL

 MECHANICAL

 SANITARY

 PLUMBING

 ELECTRONICS

 INTERIOR

 SURCHARGES

 PENALTIES

FOR FIRE SAFETY (BFP):

 FIRE CODE CONSTRUCTION TAX

 HOTWORKS

TOTAL

ASSESSEB
ASSESSED BY:
BY:
TERMS AND CONDITIONS:
1. The Owner/Applicant shall accomplish the prescribed Application Form, with the assistance of the concerned design
professional/s and/or the Architect/Civil Engineer, hired/commissioned by him/her as full-time inspector/supervisor of the
construction works, by filling up the necessary data / information required thereat.

2. The fully accomplished prescribed Application Form, duly notarized, shall be submitted to the concerned Office of the
Building Official, accompanied by the various applicable ancillary and accessory permits, plans and specifications signed
and sealed by the corresponding design professionals who shall be responsible for the comprehensive and correctness
of the plans in compliance to the National Building Code of the Philippines (PD 1096), its Revised IRR and all applicable
referral codes and professional regulatory laws, together with the other documentary requirements pursuant to Section
302 of PD 1096 and its Revised IRR.

I have read this form, understood its contents and consent to the processing of my personal data. I understand that my consent
does not preclude the existence of other criteria for lawful processing of personal data, and does not waive any of my rights under
the Data Privacy Act of 2012 and other applicable laws.

___________________________________________________
SIGNATURE OVER PRINTED NAME OF OWNER/APPLICANT
 BOX 6 (TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION)

BASIS OF AMOUNT
ASSESSED FEES ACCOUNT ASSESSED BY
ASSESSMENT DUE
FOR ZONING (ZONING
ADMINISTRATOR):
 LOCATIONAL / ZONING OF LAND

FOR BUILDING / STRUCTURE (OBO):

 FILIN
FILING FEE
 G FEE
 LINE AND GRADE (Geodetic)

 FENCING

 ARCHITECTURAL

 CIVIL / STRUCTURAL

 ELECTRICAL
MR. ARTEMIO S. PUYAWAN
 MECHANICAL

 SANITARY

 PLUMBING

 ELECTRONICS

 INTERIOR

 SURCHARGES

 PENALTIES

FOR FIRE SAFETY (BFP):

 FIRE CODE CONSTRUCTION TAX

 HOTWORKS

TOTAL

TERMS AND CONDITIONS:

1. The Owner/Applicant shall accomplish the prescribed Application Form, with the assistance of the concerned design
professional/s and/or the Architect/Civil Engineer, hired/commissioned by him/her as full-time inspector/supervisor of the
construction works, by filling up the necessary data / information required thereat.

2. The fully accomplished prescribed Application Form, duly notarized, shall be submitted to the concerned Office of the
Building Official, accompanied by the various applicable ancillary and accessory permits, plans and specifications signed
and sealed by the corresponding design professionals who shall be responsible for the comprehensive and correctness
of the plans in compliance to the National Building Code of the Philippines (PD 1096), its Revised IRR and all applicable
referral codes and professional regulatory laws, together with the other documentary requirements pursuant to Section
302 of PD 1096 and its Revised IRR.

I have read this form, understood its contents and consent to the processing of my personal data. I understand that my consent
does not preclude the existence of other criteria for lawful processing of personal data, and does not waive any of my rights under
the Data Privacy Act of 2012 and other applicable laws.

___________________________________________________
SIGNATURE OVER PRINTED NAME OF OWNER/APPLICANT